PROJECT SUMMARY Advanced non-small cell lung cancer (NSCLC) disproportionately affects older adults, but they are the least studied in cancer research. Treatments for lung cancer are evolving rapidly, resulting in improved overall survival even for patients with advanced disease. The impact of newer treatments such as immune checkpoint inhibitors (ICIs) and combination therapy on functional status, the ability to recover worsening functional status (resiliency), and clinical factors (i.e. treatment toxicity & disease response) for older adults is unknown. The majority of older adults with cancer prioritize maintaining functional independence (i.e. no disability) over survival. Despite this common desire among older adults, worsening functional status is a common consequence of cancer treatment and is often not monitored throughout treatment. Among older adults with NSCLC, symptoms such as anxiety, depression, and poor quality of life are common and are potential determinants of whether patients are able to recover their functional status (resiliency) during treatment. Interventions focusing on helping older adults to maintain functional status and improve resiliency at this time are urgently needed. Dr. Presley's overall goal is to conduct research to understand the problem of functional disability following cancer diagnosis and to develop empirically supported strategies to prevent the loss of functional status in older adults with advanced lung cancer. To this end, the objectives of this application are: 1) to improve our understanding of functional status and resiliency among a cohort of older adults with advanced NSCLC; and 2) to use this information to pilot a novel intervention targeting physical performance and negative mood ? two modifiable risk factors for worsening functional status among older adults undergoing active treatment for advanced NSCLC. To meet these objectives, we will characterize functional status, resiliency, and important clinical factors (i.e. treatment toxicity & disease response) in older adults with advanced NSCLC in an ongoing prospective cohort study at The Ohio State University (Beating Lung Cancer in Ohio). We will evaluate the association between clinical factors and outcomes: functional status and resiliency in these patients. Refined with information from the first objective, a subset of patients will participate in a pilot study, testing an intervention to improve functional status (via physical therapy) and reduce negative mood (via progressive muscle relaxation, PMR) at regularly scheduled clinic visits in conjunction with virtual health. The pilot intervention is designed to minimize treatment burden for this vulnerable patient population. This will be one of the first studies to describe how treatment with ICIs affect older adults in terms of functional status (i.e., activities of daily living and mobility). This award will provide the support necessary to advance Dr. Presley's knowledge of intervention studies among older adults. Her mentorship team includes experts in oncology, geriatrics, geriatric oncology, psychology, exercise interventions, & statistics, all selected to advance Dr. Presley's research design, quantitative, project management, and leadership skills.